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<td style="vertical-align:top; width:36px; height:23px; background-color:#c0c0c0; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 8pt; font-weight: bold;">Form No.</span></p>
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<td style="vertical-align:top; width:152px; height:23px; background-color:#c0c0c0; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 8pt; font-weight: bold;">Form Label</span></p>
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<td style="vertical-align:top; width:111px; height:23px; background-color:#c0c0c0; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 8pt; font-weight: bold;">Field Name</span></p>
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<td style="vertical-align:top; width:228px; height:23px; background-color:#c0c0c0; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 8pt; font-weight: bold;">Business Rule</span></p>
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<td style="vertical-align:top; width:63px; height:23px; background-color:#c0c0c0; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 8pt; font-weight: bold;">Required for Saving</span></p>
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<td style="vertical-align:top; width:51px; height:23px; background-color:#c0c0c0; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 8pt; font-weight: bold;">Minimum Reporting</span></p>
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<td style="vertical-align:top; width:62px; height:23px; background-color:#c0c0c0; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 8pt; font-weight: bold;">Minimum Clinical</span></p>
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<td style="vertical-align:top; width:36px; height:12px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 8pt;">1</span></p>
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<td style="vertical-align:top; width:152px; height:12px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 8pt; font-weight: bold;">First Name</span></p>
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<td style="vertical-align:top; width:130px; height:12px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 8pt; font-weight: bold;">mst_Patient </span></p>
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<td style="vertical-align:top; width:111px; height:12px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 8pt;">FirstName</span></p>
</td>
<td style="vertical-align:top; width:228px; height:12px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 8pt;">Auto filled</span></p>
</td>
<td style="vertical-align:top; width:63px; height:12px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 8pt;">Yes</span></p>
</td>
<td style="vertical-align:top; width:51px; height:12px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 8pt;">Yes</span></p>
</td>
<td style="vertical-align:top; width:62px; height:12px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 8pt;">Yes</span></p>
</td>
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<tr style="text-align:left;vertical-align:top;">
<td style="vertical-align:top; width:36px; height:12px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 8pt;">1</span></p>
</td>
<td style="vertical-align:top; width:152px; height:12px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 8pt; font-weight: bold;">Last Name</span></p>
</td>
<td style="vertical-align:top; width:130px; height:12px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 8pt; font-weight: bold;">mst_Patient </span></p>
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<td style="vertical-align:top; width:111px; height:12px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 8pt;">LastName</span></p>
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<td style="vertical-align:top; width:228px; height:12px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 8pt;">Auto filled</span></p>
</td>
<td style="vertical-align:top; width:63px; height:12px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 8pt;">Yes</span></p>
</td>
<td style="vertical-align:top; width:51px; height:12px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 8pt;">Yes</span></p>
</td>
<td style="vertical-align:top; width:62px; height:12px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 8pt;">Yes</span></p>
</td>
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<tr style="text-align:left;vertical-align:top;">
<td style="vertical-align:top; width:36px; height:23px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 8pt;">2</span></p>
</td>
<td style="vertical-align:top; width:152px; height:23px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 8pt; font-weight: bold;">Visit Date</span></p>
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<td style="vertical-align:top; width:130px; height:23px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 8pt; font-weight: bold;">ord_Visit </span></p>
</td>
<td style="vertical-align:top; width:111px; height:23px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 8pt;">VisitDate</span></p>
</td>
<td style="vertical-align:top; width:228px; height:23px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 8pt;">Date on which the patient came into the clinic.</span></p>
<p style="margin: 0px 0px 0px 0px;"><span style="font-size: 8pt;">No future dates allowed - like 2020</span></p>
</td>
<td style="vertical-align:top; width:63px; height:23px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 8pt;">Yes</span></p>
</td>
<td style="vertical-align:top; width:51px; height:23px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 8pt;">Yes</span></p>
</td>
<td style="vertical-align:top; width:62px; height:23px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 8pt;">Yes</span></p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td style="vertical-align:top; width:36px; height:12px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 8pt;">3</span></p>
</td>
<td style="vertical-align:top; width:152px; height:12px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 8pt; font-weight: bold;">ID - Country</span></p>
</td>
<td style="vertical-align:top; width:130px; height:12px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 8pt; font-weight: bold;">mst_Facility </span></p>
</td>
<td style="vertical-align:top; width:111px; height:12px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 8pt;">CountryID</span></p>
</td>
<td style="vertical-align:top; width:228px; height:12px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 8pt;">Auto filled</span></p>
</td>
<td style="vertical-align:top; width:63px; height:12px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 8pt;">Yes</span></p>
</td>
<td style="vertical-align:top; width:51px; height:12px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 8pt;">Yes</span></p>
</td>
<td style="vertical-align:top; width:62px; height:12px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="color: #000000;">&nbsp;</span></p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td style="vertical-align:top; width:36px; height:12px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 8pt;">3</span></p>
</td>
<td style="vertical-align:top; width:152px; height:12px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 8pt; font-weight: bold;">ID - LPTF#</span></p>
</td>
<td style="vertical-align:top; width:130px; height:12px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 8pt; font-weight: bold;">mst_Facility </span></p>
</td>
<td style="vertical-align:top; width:111px; height:12px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 8pt;">PosID</span></p>
</td>
<td style="vertical-align:top; width:228px; height:12px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 8pt;">Auto filled</span></p>
</td>
<td style="vertical-align:top; width:63px; height:12px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 8pt;">Yes</span></p>
</td>
<td style="vertical-align:top; width:51px; height:12px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 8pt;">Yes</span></p>
</td>
<td style="vertical-align:top; width:62px; height:12px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="color: #000000;">&nbsp;</span></p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td style="vertical-align:top; width:36px; height:12px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 8pt;">3</span></p>
</td>
<td style="vertical-align:top; width:152px; height:12px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 8pt; font-weight: bold;">ID - Satellite #</span></p>
</td>
<td style="vertical-align:top; width:130px; height:12px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 8pt; font-weight: bold;">mst_Facility </span></p>
</td>
<td style="vertical-align:top; width:111px; height:12px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 8pt;">satelliteID</span></p>
</td>
<td style="vertical-align:top; width:228px; height:12px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 8pt;">Auto filled</span></p>
</td>
<td style="vertical-align:top; width:63px; height:12px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 8pt;">Yes</span></p>
</td>
<td style="vertical-align:top; width:51px; height:12px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 8pt;">Yes</span></p>
</td>
<td style="vertical-align:top; width:62px; height:12px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="color: #000000;">&nbsp;</span></p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td style="vertical-align:top; width:36px; height:12px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 8pt;">3</span></p>
</td>
<td style="vertical-align:top; width:152px; height:12px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 8pt; font-weight: bold;">ID - Patient Enrollment Number</span></p>
</td>
<td style="vertical-align:top; width:130px; height:12px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 8pt; font-weight: bold;">mst_Patient </span></p>
</td>
<td style="vertical-align:top; width:111px; height:12px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 8pt;">PatientEnrollmentID</span></p>
</td>
<td style="vertical-align:top; width:228px; height:12px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 8pt;">Auto filled</span></p>
</td>
<td style="vertical-align:top; width:63px; height:12px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 8pt;">Yes</span></p>
</td>
<td style="vertical-align:top; width:51px; height:12px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 8pt;">Yes</span></p>
</td>
<td style="vertical-align:top; width:62px; height:12px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="color: #000000;">&nbsp;</span></p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td style="vertical-align:top; width:36px; height:12px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 8pt;">4</span></p>
</td>
<td style="vertical-align:top; width:152px; height:12px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 8pt; font-weight: bold;">Existing Hosp/Clinic #</span></p>
</td>
<td style="vertical-align:top; width:130px; height:12px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 8pt; font-weight: bold;">mst_Patient </span></p>
</td>
<td style="vertical-align:top; width:111px; height:12px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 8pt;">PatientClinicID</span></p>
</td>
<td style="vertical-align:top; width:228px; height:12px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 8pt;">Auto filled</span></p>
</td>
<td style="vertical-align:top; width:63px; height:12px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 8pt;">Yes</span></p>
</td>
<td style="vertical-align:top; width:51px; height:12px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="color: #000000;">&nbsp;</span></p>
</td>
<td style="vertical-align:top; width:62px; height:12px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 8pt;">Yes</span></p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td style="vertical-align:top; width:36px; height:12px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 8pt;">6</span></p>
</td>
<td style="vertical-align:top; width:152px; height:12px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 8pt; font-weight: bold;">Last CD4 Count</span></p>
</td>
<td style="vertical-align:top; width:130px; height:12px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 8pt; font-weight: bold;">dtl_PatientLabResult</span></p>
</td>
<td style="vertical-align:top; width:111px; height:12px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 8pt;">TestResults</span></p>
</td>
<td style="vertical-align:top; width:228px; height:12px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 8pt;">Auto populate</span></p>
</td>
<td style="vertical-align:top; width:63px; height:12px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="color: #000000;">&nbsp;</span></p>
</td>
<td style="vertical-align:top; width:51px; height:12px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="color: #000000;">&nbsp;</span></p>
</td>
<td style="vertical-align:top; width:62px; height:12px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="color: #000000;">&nbsp;</span></p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td style="vertical-align:top; width:36px; height:12px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 8pt;">6</span></p>
</td>
<td style="vertical-align:top; width:152px; height:12px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 8pt; font-weight: bold;">Last CD4 Count Date</span></p>
</td>
<td style="vertical-align:top; width:130px; height:12px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 8pt; font-weight: bold;">ord_PatientLabOrder </span></p>
</td>
<td style="vertical-align:top; width:111px; height:12px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 8pt;">ReportedbyDate</span></p>
</td>
<td style="vertical-align:top; width:228px; height:12px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 8pt;">Auto populate</span></p>
</td>
<td style="vertical-align:top; width:63px; height:12px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="color: #000000;">&nbsp;</span></p>
</td>
<td style="vertical-align:top; width:51px; height:12px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="color: #000000;">&nbsp;</span></p>
</td>
<td style="vertical-align:top; width:62px; height:12px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="color: #000000;">&nbsp;</span></p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td style="vertical-align:top; width:36px; height:23px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 8pt;">6a</span></p>
</td>
<td style="vertical-align:top; width:152px; height:23px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 8pt; font-weight: bold;">CD4 prior to starting ARV</span></p>
</td>
<td style="vertical-align:top; width:130px; height:23px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 8pt; font-family: Tahoma; font-weight: bold;">dtl_PatientHivPrevCareIE </span></p>
</td>
<td style="vertical-align:top; width:111px; height:23px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 8pt;">PriorARVsCD4</span></p>
</td>
<td colspan="4" style="vertical-align:top; width:228px; height:23px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 8pt;">Non-editable, auto populated field from the IE form. Manual updates must be done via the IE form.</span></p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td style="vertical-align:top; width:36px; height:23px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 8pt;">6a</span></p>
</td>
<td style="vertical-align:top; width:152px; height:23px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 8pt; font-weight: bold;">CD4 prior to starting ARV Date</span></p>
</td>
<td style="vertical-align:top; width:130px; height:23px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 8pt; font-family: Tahoma; font-weight: bold;">dtl_PatientHivPrevCareIE </span></p>
</td>
<td style="vertical-align:top; width:111px; height:23px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 8pt;">PriorARVsCD4Date</span></p>
</td>
<td colspan="4" style="vertical-align:top; width:228px; height:23px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 8pt;">Auto populate from the IE form, OR fill in manually; the manually updated data should update the IE form field.</span></p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td style="vertical-align:top; width:36px; height:12px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 8pt;">7</span></p>
</td>
<td style="vertical-align:top; width:152px; height:12px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 8pt; font-weight: bold;">Last Viral Load</span></p>
</td>
<td style="vertical-align:top; width:130px; height:12px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 8pt; font-weight: bold;">dtl_PatientLabResult</span></p>
</td>
<td style="vertical-align:top; width:111px; height:12px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 8pt;">TestResults</span></p>
</td>
<td style="vertical-align:top; width:228px; height:12px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 8pt;">Auto populate</span></p>
</td>
<td style="vertical-align:top; width:63px; height:12px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="color: #000000;">&nbsp;</span></p>
</td>
<td style="vertical-align:top; width:51px; height:12px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="color: #000000;">&nbsp;</span></p>
</td>
<td style="vertical-align:top; width:62px; height:12px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="color: #000000;">&nbsp;</span></p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td style="vertical-align:top; width:36px; height:12px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 8pt;">7</span></p>
</td>
<td style="vertical-align:top; width:152px; height:12px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 8pt; font-weight: bold;">Last Viral Load Date</span></p>
</td>
<td style="vertical-align:top; width:130px; height:12px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 8pt; font-weight: bold;">ord_PatientLabOrder </span></p>
</td>
<td style="vertical-align:top; width:111px; height:12px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 8pt;">OrderedbyName</span></p>
</td>
<td style="vertical-align:top; width:228px; height:12px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 8pt;">Auto populate</span></p>
</td>
<td style="vertical-align:top; width:63px; height:12px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="color: #000000;">&nbsp;</span></p>
</td>
<td style="vertical-align:top; width:51px; height:12px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="color: #000000;">&nbsp;</span></p>
</td>
<td style="vertical-align:top; width:62px; height:12px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="color: #000000;">&nbsp;</span></p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td style="vertical-align:top; width:36px; height:126px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 8pt;">8a</span></p>
</td>
<td style="vertical-align:top; width:152px; height:126px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 8pt; font-weight: bold;">Current Regimen Began</span></p>
</td>
<td style="vertical-align:top; width:130px; height:126px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 8pt; font-weight: bold;">dtl_PatientArvTherapy</span></p>
</td>
<td style="vertical-align:top; width:111px; height:126px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 8pt;">PrescribedARVStartDate</span></p>
</td>
<td colspan="4" style="vertical-align:top; width:228px; height:126px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 8pt;">Auto populate</span></p>
<p style="margin: 0px 0px 0px 0px;"><span style="font-size: 8pt;">Date started or changed to new regimen; Check for the latest date (and associated regimen)</span></p>
<p style="margin: 0px 0px 0px 0px;"><span style="font-size: 8pt;">1) check the last FU form for the latest ARV regimen started or changed - and then use the DispensedByDate for the date; use the compilation of the ARVs as the Regimen</span></p>
<p style="margin: 0px 0px 0px 0px;"><span style="font-size: 8pt;">2) if there isn’t a FU form, then check the IE form started or changed - and then use the DispensedByDate for the date; use the compilation of the ARVs as the Regimen</span></p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td style="vertical-align:top; width:36px; height:57px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 8pt;">8b</span></p>
</td>
<td style="vertical-align:top; width:152px; height:57px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 8pt; font-weight: bold;">Regimen (Current)</span></p>
</td>
<td style="vertical-align:top; width:130px; height:57px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 8pt; font-weight: bold;">dtl_RegimenMap</span></p>
</td>
<td style="vertical-align:top; width:111px; height:57px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 8pt;">RegimenType</span></p>
</td>
<td colspan="4" style="vertical-align:top; width:228px; height:57px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 8pt;">Auto populate- the information is coming from the adult or pedi pharmacy form and should reside in the regimen map table</span></p>
<p style="margin: 0px 0px 0px 0px;"><span style="font-size: 8pt;">Note the format of the Regimen is AAA/BBB/CCC - use of forward slashes between the abbreviations</span></p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td style="vertical-align:top; width:36px; height:23px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 8pt;">9</span></p>
</td>
<td style="vertical-align:top; width:152px; height:23px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 8pt; font-weight: bold;">Pregnant</span></p>
</td>
<td style="vertical-align:top; width:130px; height:23px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 8pt; font-family: Tahoma; font-weight: bold;">dtl_PatientClinicalStatus </span></p>
</td>
<td style="vertical-align:top; width:111px; height:23px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 8pt;">Pregnant</span></p>
</td>
<td colspan="2" style="vertical-align:top; width:228px; height:23px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 8pt;">Should only display if the patient has Gender=female</span></p>
<p style="margin: 0px 0px 0px 0px;"><span style="font-size: 8pt;">This should be defaulted to &quot;No&quot;</span></p>
</td>
<td style="vertical-align:top; width:51px; height:23px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 8pt;">Yes</span></p>
</td>
<td style="vertical-align:top; width:62px; height:23px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 8pt;">Yes</span></p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td style="vertical-align:top; width:36px; height:23px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 8pt;">9</span></p>
</td>
<td style="vertical-align:top; width:152px; height:23px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 8pt; font-weight: bold;">LMP</span></p>
</td>
<td style="vertical-align:top; width:130px; height:23px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 8pt; font-family: Tahoma; font-weight: bold;">dtl_PatientClinicalStatus </span></p>
</td>
<td style="vertical-align:top; width:111px; height:23px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 8pt;">LMP</span></p>
</td>
<td colspan="4" style="vertical-align:top; width:228px; height:23px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 8pt;">LMP= Last Menstral Period</span></p>
<p style="margin: 0px 0px 0px 0px;"><span style="font-size: 8pt;">Should only display if the patient has Gender=female</span></p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td style="vertical-align:top; width:36px; height:12px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="color: #000000;">&nbsp;</span></p>
</td>
<td style="vertical-align:top; width:152px; height:12px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="color: #000000;">&nbsp;</span></p>
</td>
<td style="vertical-align:top; width:130px; height:12px; padding:0px; border:solid 1px #000000;"><p style="text-align: right; margin: 0px 0px 0px 0px;"><span style="color: #000000;">&nbsp;</span></p>
</td>
<td style="vertical-align:top; width:111px; height:12px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="color: #000000;">&nbsp;</span></p>
</td>
<td style="vertical-align:top; width:228px; height:12px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="color: #000000;">&nbsp;</span></p>
</td>
<td style="vertical-align:top; width:63px; height:12px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="color: #000000;">&nbsp;</span></p>
</td>
<td style="vertical-align:top; width:51px; height:12px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="color: #000000;">&nbsp;</span></p>
</td>
<td style="vertical-align:top; width:62px; height:12px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="color: #000000;">&nbsp;</span></p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td style="vertical-align:top; width:36px; height:12px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="color: #000000;">&nbsp;</span></p>
</td>
<td style="vertical-align:top; width:152px; height:12px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 8pt; font-weight: bold;">Adherence</span></p>
</td>
<td style="vertical-align:top; width:130px; height:12px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="color: #000000;">&nbsp;</span></p>
</td>
<td style="vertical-align:top; width:111px; height:12px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="color: #000000;">&nbsp;</span></p>
</td>
<td style="vertical-align:top; width:228px; height:12px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="color: #000000;">&nbsp;</span></p>
</td>
<td style="vertical-align:top; width:63px; height:12px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="color: #000000;">&nbsp;</span></p>
</td>
<td style="vertical-align:top; width:51px; height:12px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="color: #000000;">&nbsp;</span></p>
</td>
<td style="vertical-align:top; width:62px; height:12px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="color: #000000;">&nbsp;</span></p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td style="vertical-align:top; width:36px; height:80px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 8pt;">10</span></p>
</td>
<td style="vertical-align:top; width:152px; height:80px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 8pt; font-weight: bold;">Number of doses missed last week</span></p>
</td>
<td style="vertical-align:top; width:130px; height:80px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 8pt; font-weight: bold;">dtl_PatientAdherence</span></p>
</td>
<td style="vertical-align:top; width:111px; height:80px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 8pt;">MissedLastWeek</span></p>
</td>
<td colspan="3" style="vertical-align:top; width:228px; height:80px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 8pt;">If None checked, then MissedLastWeek= 0 and the UI should be blanked out or hidden</span></p>
<p style="margin: 0px 0px 0px 0px;"><span style="font-size: 8pt;">Add not documented botton for the Number of doses missed last week and/or last month - if nothing is in the form for either of these items, the data entry person will be able to check that is was not documented.</span></p>
</td>
<td style="vertical-align:top; width:62px; height:80px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 8pt;">Yes or check &quot;None&quot;</span></p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td style="vertical-align:top; width:36px; height:23px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 8pt;">10</span></p>
</td>
<td style="vertical-align:top; width:152px; height:23px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 8pt; font-weight: bold;">Number of doses missed last month</span></p>
</td>
<td style="vertical-align:top; width:130px; height:23px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 8pt; font-weight: bold;">dtl_PatientAdherence</span></p>
</td>
<td style="vertical-align:top; width:111px; height:23px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 8pt;">MissedLastMonth</span></p>
</td>
<td colspan="4" style="vertical-align:top; width:228px; height:23px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 8pt;">If None checked, then MissedLastMonthe= 0 and the UI should be blanked out or hidden</span></p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td style="vertical-align:top; width:36px; height:12px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 8pt;">10</span></p>
</td>
<td style="vertical-align:top; width:152px; height:12px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 8pt; font-weight: bold;">Number of DOT times/week</span></p>
</td>
<td style="vertical-align:top; width:130px; height:12px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 8pt; font-weight: bold;">dtl_PatientAdherence</span></p>
</td>
<td style="vertical-align:top; width:111px; height:12px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 8pt;">NumDOTPerWeek</span></p>
</td>
<td style="vertical-align:top; width:228px; height:12px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="color: #000000;">&nbsp;</span></p>
</td>
<td style="vertical-align:top; width:63px; height:12px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="color: #000000;">&nbsp;</span></p>
</td>
<td style="vertical-align:top; width:51px; height:12px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="color: #000000;">&nbsp;</span></p>
</td>
<td style="vertical-align:top; width:62px; height:12px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="color: #000000;">&nbsp;</span></p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td style="vertical-align:top; width:36px; height:23px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 8pt;">10</span></p>
</td>
<td style="vertical-align:top; width:152px; height:23px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 8pt; font-weight: bold;">Number of Home visits times/week</span></p>
</td>
<td style="vertical-align:top; width:130px; height:23px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 8pt; font-weight: bold;">dtl_PatientAdherence</span></p>
</td>
<td colspan="2" style="vertical-align:top; width:111px; height:23px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 8pt;">NumHomeVisitsPerWeek</span></p>
</td>
<td style="vertical-align:top; width:63px; height:23px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="color: #000000;">&nbsp;</span></p>
</td>
<td style="vertical-align:top; width:51px; height:23px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="color: #000000;">&nbsp;</span></p>
</td>
<td style="vertical-align:top; width:62px; height:23px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="color: #000000;">&nbsp;</span></p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td style="vertical-align:top; width:36px; height:12px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 8pt;">10</span></p>
</td>
<td style="vertical-align:top; width:152px; height:12px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 8pt; font-weight: bold;">Support group</span></p>
</td>
<td style="vertical-align:top; width:130px; height:12px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 8pt; font-weight: bold;">dtl_PatientAdherence</span></p>
</td>
<td style="vertical-align:top; width:111px; height:12px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 8pt;">SupportGroup</span></p>
</td>
<td style="vertical-align:top; width:228px; height:12px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="color: #000000;">&nbsp;</span></p>
</td>
<td style="vertical-align:top; width:63px; height:12px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="color: #000000;">&nbsp;</span></p>
</td>
<td style="vertical-align:top; width:51px; height:12px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="color: #000000;">&nbsp;</span></p>
</td>
<td style="vertical-align:top; width:62px; height:12px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="color: #000000;">&nbsp;</span></p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td style="vertical-align:top; width:36px; height:23px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 8pt;">10</span></p>
</td>
<td style="vertical-align:top; width:152px; height:23px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 8pt; font-weight: bold;">Rx was interrupted (unintentional)</span></p>
</td>
<td style="vertical-align:top; width:130px; height:23px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 8pt; font-weight: bold;">dtl_PatientAdherence</span></p>
</td>
<td style="vertical-align:top; width:111px; height:23px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 8pt;">Interrupted</span></p>
</td>
<td style="vertical-align:top; width:228px; height:23px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="color: #000000;">&nbsp;</span></p>
</td>
<td style="vertical-align:top; width:63px; height:23px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="color: #000000;">&nbsp;</span></p>
</td>
<td style="vertical-align:top; width:51px; height:23px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="color: #000000;">&nbsp;</span></p>
</td>
<td style="vertical-align:top; width:62px; height:23px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="color: #000000;">&nbsp;</span></p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td style="vertical-align:top; width:36px; height:23px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 8pt;">10</span></p>
</td>
<td style="vertical-align:top; width:152px; height:23px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 8pt; font-weight: bold;">Rx interrupted date</span></p>
</td>
<td style="vertical-align:top; width:130px; height:23px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 8pt; font-weight: bold;">dtl_PatientAdherence</span></p>
</td>
<td style="vertical-align:top; width:111px; height:23px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 8pt;">InterruptedDate</span></p>
</td>
<td colspan="3" style="vertical-align:top; width:228px; height:23px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 8pt;">Only one of RX interrupted or RX stopped can be selected.</span></p>
</td>
<td style="vertical-align:top; width:62px; height:23px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="color: #000000;">&nbsp;</span></p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td style="vertical-align:top; width:36px; height:12px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 8pt;">10</span></p>
</td>
<td style="vertical-align:top; width:152px; height:12px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 8pt; font-weight: bold;">Number of days Rx interrupted</span></p>
</td>
<td style="vertical-align:top; width:130px; height:12px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 8pt; font-weight: bold;">dtl_PatientAdherence</span></p>
</td>
<td style="vertical-align:top; width:111px; height:12px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 8pt;">InterruptedNumDays</span></p>
</td>
<td style="vertical-align:top; width:228px; height:12px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="color: #000000;">&nbsp;</span></p>
</td>
<td style="vertical-align:top; width:63px; height:12px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="color: #000000;">&nbsp;</span></p>
</td>
<td style="vertical-align:top; width:51px; height:12px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="color: #000000;">&nbsp;</span></p>
</td>
<td style="vertical-align:top; width:62px; height:12px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="color: #000000;">&nbsp;</span></p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td style="vertical-align:top; width:36px; height:12px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="color: #000000;">&nbsp;</span></p>
</td>
<td style="vertical-align:top; width:152px; height:12px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 8pt; font-weight: bold;">Rx was stopped (intentional)</span></p>
</td>
<td style="vertical-align:top; width:130px; height:12px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 8pt; font-weight: bold;">dtl_PatientAdherence</span></p>
</td>
<td style="vertical-align:top; width:111px; height:12px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 8pt;">StoppedNumDays</span></p>
</td>
<td style="vertical-align:top; width:228px; height:12px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="color: #000000;">&nbsp;</span></p>
</td>
<td style="vertical-align:top; width:63px; height:12px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="color: #000000;">&nbsp;</span></p>
</td>
<td style="vertical-align:top; width:51px; height:12px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="color: #000000;">&nbsp;</span></p>
</td>
<td style="vertical-align:top; width:62px; height:12px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="color: #000000;">&nbsp;</span></p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td style="vertical-align:top; width:36px; height:12px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="color: #000000;">&nbsp;</span></p>
</td>
<td style="vertical-align:top; width:152px; height:12px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 8pt; font-weight: bold;">Rx stopped date</span></p>
</td>
<td style="vertical-align:top; width:130px; height:12px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 8pt; font-weight: bold;">dtl_PatientAdherence</span></p>
</td>
<td style="vertical-align:top; width:111px; height:12px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 8pt; font-family: Tahoma;">StoppedDate</span></p>
</td>
<td style="vertical-align:top; width:228px; height:12px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="color: #000000;">&nbsp;</span></p>
</td>
<td style="vertical-align:top; width:63px; height:12px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="color: #000000;">&nbsp;</span></p>
</td>
<td style="vertical-align:top; width:51px; height:12px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="color: #000000;">&nbsp;</span></p>
</td>
<td style="vertical-align:top; width:62px; height:12px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="color: #000000;">&nbsp;</span></p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td style="vertical-align:top; width:36px; height:23px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="color: #000000;">&nbsp;</span></p>
</td>
<td style="vertical-align:top; width:152px; height:23px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 8pt; font-weight: bold;">Reason Missed </span></p>
</td>
<td style="vertical-align:top; width:130px; height:23px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 8pt; font-weight: bold;">dtl_PatientAdherence</span></p>
</td>
<td style="vertical-align:top; width:111px; height:23px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 8pt;">MissedReason</span></p>
</td>
<td colspan="2" style="vertical-align:top; width:228px; height:23px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 8pt;">One of the Adherence codes; More than one can apply.</span></p>
</td>
<td style="vertical-align:top; width:51px; height:23px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="color: #000000;">&nbsp;</span></p>
</td>
<td style="vertical-align:top; width:62px; height:23px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="color: #000000;">&nbsp;</span></p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td style="vertical-align:top; width:36px; height:12px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 8pt;">10</span></p>
</td>
<td style="vertical-align:top; width:152px; height:12px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 8pt; font-weight: bold;">Reason Missed Other</span></p>
</td>
<td style="vertical-align:top; width:130px; height:12px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 8pt; font-weight: bold;">dtl_PatientAdherence</span></p>
</td>
<td style="vertical-align:top; width:111px; height:12px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 8pt;">MissedReasonOther</span></p>
</td>
<td style="vertical-align:top; width:228px; height:12px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="color: #000000;">&nbsp;</span></p>
</td>
<td style="vertical-align:top; width:63px; height:12px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="color: #000000;">&nbsp;</span></p>
</td>
<td style="vertical-align:top; width:51px; height:12px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="color: #000000;">&nbsp;</span></p>
</td>
<td style="vertical-align:top; width:62px; height:12px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="color: #000000;">&nbsp;</span></p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td style="vertical-align:top; width:36px; height:23px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 8pt;">10</span></p>
</td>
<td style="vertical-align:top; width:152px; height:23px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 8pt; font-weight: bold;">Patient reports taking herbal medications</span></p>
</td>
<td style="vertical-align:top; width:130px; height:23px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 8pt; font-weight: bold;">dtl_PatientAdherence</span></p>
</td>
<td style="vertical-align:top; width:111px; height:23px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 8pt;">HerbalMeds</span></p>
</td>
<td style="vertical-align:top; width:228px; height:23px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="color: #000000;">&nbsp;</span></p>
</td>
<td style="vertical-align:top; width:63px; height:23px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="color: #000000;">&nbsp;</span></p>
</td>
<td style="vertical-align:top; width:51px; height:23px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="color: #000000;">&nbsp;</span></p>
</td>
<td style="vertical-align:top; width:62px; height:23px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="color: #000000;">&nbsp;</span></p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td style="vertical-align:top; width:36px; height:12px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="color: #000000;">&nbsp;</span></p>
</td>
<td style="vertical-align:top; width:152px; height:12px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 8pt; font-weight: bold;">Presenting Complaints</span></p>
</td>
<td style="vertical-align:top; width:130px; height:12px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="color: #000000;">&nbsp;</span></p>
</td>
<td style="vertical-align:top; width:111px; height:12px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="color: #000000;">&nbsp;</span></p>
</td>
<td style="vertical-align:top; width:228px; height:12px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="color: #000000;">&nbsp;</span></p>
</td>
<td style="vertical-align:top; width:63px; height:12px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="color: #000000;">&nbsp;</span></p>
</td>
<td style="vertical-align:top; width:51px; height:12px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="color: #000000;">&nbsp;</span></p>
</td>
<td style="vertical-align:top; width:62px; height:12px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="color: #000000;">&nbsp;</span></p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td style="vertical-align:top; width:36px; height:23px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 8pt;">11</span></p>
</td>
<td style="vertical-align:top; width:152px; height:23px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 8pt; font-weight: bold;">Presenting Complaints</span></p>
</td>
<td style="vertical-align:top; width:130px; height:23px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 8pt; font-weight: bold;">dtl_PatientSymptoms </span></p>
</td>
<td style="vertical-align:top; width:111px; height:23px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 8pt;">SymptomID</span></p>
</td>
<td colspan="4" style="vertical-align:top; width:228px; height:23px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 8pt;">Default the UI to None; if other complaints are selected, None becomes de-selected.</span></p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td colspan="2" style="vertical-align:top; width:36px; height:12px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 8pt; font-weight: bold;">TB Screening</span></p>
</td>
<td style="vertical-align:top; width:130px; height:12px; padding:0px; border:solid 1px #000000;"><p style="text-align: right; margin: 0px 0px 0px 0px;"><span style="color: #000000;">&nbsp;</span></p>
</td>
<td style="vertical-align:top; width:111px; height:12px; padding:0px; border:solid 1px #000000;"><p style="text-align: right; margin: 0px 0px 0px 0px;"><span style="color: #000000;">&nbsp;</span></p>
</td>
<td style="vertical-align:top; width:228px; height:12px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="color: #000000;">&nbsp;</span></p>
</td>
<td style="vertical-align:top; width:63px; height:12px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="color: #000000;">&nbsp;</span></p>
</td>
<td style="vertical-align:top; width:51px; height:12px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="color: #000000;">&nbsp;</span></p>
</td>
<td style="vertical-align:top; width:62px; height:12px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="color: #000000;">&nbsp;</span></p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td style="vertical-align:top; width:36px; height:12px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="color: #000000;">&nbsp;</span></p>
</td>
<td style="vertical-align:top; width:152px; height:12px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 8pt; font-weight: bold;">Not documented</span></p>
</td>
<td style="vertical-align:top; width:130px; height:12px; padding:0px; border:solid 1px #000000;"><p style="text-align: right; margin: 0px 0px 0px 0px;"><span style="color: #000000;">&nbsp;</span></p>
</td>
<td style="vertical-align:top; width:111px; height:12px; padding:0px; border:solid 1px #000000;"><p style="text-align: right; margin: 0px 0px 0px 0px;"><span style="color: #000000;">&nbsp;</span></p>
</td>
<td style="vertical-align:top; width:228px; height:12px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="color: #000000;">&nbsp;</span></p>
</td>
<td style="vertical-align:top; width:63px; height:12px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="color: #000000;">&nbsp;</span></p>
</td>
<td style="vertical-align:top; width:51px; height:12px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="color: #000000;">&nbsp;</span></p>
</td>
<td style="vertical-align:top; width:62px; height:12px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="color: #000000;">&nbsp;</span></p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td style="vertical-align:top; width:36px; height:12px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="color: #000000;">&nbsp;</span></p>
</td>
<td style="vertical-align:top; width:152px; height:12px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 8pt; font-weight: bold;">Performed</span></p>
</td>
<td style="vertical-align:top; width:130px; height:12px; padding:0px; border:solid 1px #000000;"><p style="text-align: right; margin: 0px 0px 0px 0px;"><span style="color: #000000;">&nbsp;</span></p>
</td>
<td style="vertical-align:top; width:111px; height:12px; padding:0px; border:solid 1px #000000;"><p style="text-align: right; margin: 0px 0px 0px 0px;"><span style="color: #000000;">&nbsp;</span></p>
</td>
<td style="vertical-align:top; width:228px; height:12px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="color: #000000;">&nbsp;</span></p>
</td>
<td style="vertical-align:top; width:63px; height:12px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="color: #000000;">&nbsp;</span></p>
</td>
<td style="vertical-align:top; width:51px; height:12px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="color: #000000;">&nbsp;</span></p>
</td>
<td style="vertical-align:top; width:62px; height:12px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="color: #000000;">&nbsp;</span></p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td style="vertical-align:top; width:36px; height:12px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="color: #000000;">&nbsp;</span></p>
</td>
<td style="vertical-align:top; width:152px; height:12px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="color: #000000;">&nbsp;</span></p>
</td>
<td style="vertical-align:top; width:130px; height:12px; padding:0px; border:solid 1px #000000;"><p style="text-align: right; margin: 0px 0px 0px 0px;"><span style="color: #000000;">&nbsp;</span></p>
</td>
<td style="vertical-align:top; width:111px; height:12px; padding:0px; border:solid 1px #000000;"><p style="text-align: right; margin: 0px 0px 0px 0px;"><span style="color: #000000;">&nbsp;</span></p>
</td>
<td style="vertical-align:top; width:228px; height:12px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="color: #000000;">&nbsp;</span></p>
</td>
<td style="vertical-align:top; width:63px; height:12px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="color: #000000;">&nbsp;</span></p>
</td>
<td style="vertical-align:top; width:51px; height:12px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="color: #000000;">&nbsp;</span></p>
</td>
<td style="vertical-align:top; width:62px; height:12px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="color: #000000;">&nbsp;</span></p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td style="vertical-align:top; width:36px; height:12px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 8pt; font-weight: bold;">13</span></p>
</td>
<td style="vertical-align:top; width:152px; height:12px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 8pt; font-weight: bold;">Physical Exam</span></p>
</td>
<td style="vertical-align:top; width:130px; height:12px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="color: #000000;">&nbsp;</span></p>
</td>
<td style="vertical-align:top; width:111px; height:12px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="color: #000000;">&nbsp;</span></p>
</td>
<td style="vertical-align:top; width:228px; height:12px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="color: #000000;">&nbsp;</span></p>
</td>
<td style="vertical-align:top; width:63px; height:12px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="color: #000000;">&nbsp;</span></p>
</td>
<td style="vertical-align:top; width:51px; height:12px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="color: #000000;">&nbsp;</span></p>
</td>
<td style="vertical-align:top; width:62px; height:12px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="color: #000000;">&nbsp;</span></p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td style="vertical-align:top; width:36px; height:12px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="color: #000000;">&nbsp;</span></p>
</td>
<td style="vertical-align:top; width:152px; height:12px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 8pt; font-weight: bold;">Temp (Degrees C)</span></p>
</td>
<td style="vertical-align:top; width:130px; height:12px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 8pt; font-weight: bold;">dtl_PatientVitals</span></p>
</td>
<td style="vertical-align:top; width:111px; height:12px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 8pt;">Temp (deg C)</span></p>
</td>
<td style="vertical-align:top; width:228px; height:12px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 8pt;">Field level validation boundaries: 30.0-50.0</span></p>
</td>
<td style="vertical-align:top; width:63px; height:12px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="color: #000000;">&nbsp;</span></p>
</td>
<td style="vertical-align:top; width:51px; height:12px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="color: #000000;">&nbsp;</span></p>
</td>
<td style="vertical-align:top; width:62px; height:12px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="color: #000000;">&nbsp;</span></p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td style="vertical-align:top; width:36px; height:12px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="color: #000000;">&nbsp;</span></p>
</td>
<td style="vertical-align:top; width:152px; height:12px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 8pt; font-weight: bold;">RR (cam)</span></p>
</td>
<td style="vertical-align:top; width:130px; height:12px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 8pt; font-weight: bold;">dtl_PatientVitals</span></p>
</td>
<td style="vertical-align:top; width:111px; height:12px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 8pt;">RR</span></p>
</td>
<td style="vertical-align:top; width:228px; height:12px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 8pt;">Field level validation boundaries: 4-100</span></p>
</td>
<td style="vertical-align:top; width:63px; height:12px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="color: #000000;">&nbsp;</span></p>
</td>
<td style="vertical-align:top; width:51px; height:12px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="color: #000000;">&nbsp;</span></p>
</td>
<td style="vertical-align:top; width:62px; height:12px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="color: #000000;">&nbsp;</span></p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td style="vertical-align:top; width:36px; height:12px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="color: #000000;">&nbsp;</span></p>
</td>
<td style="vertical-align:top; width:152px; height:12px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 8pt; font-weight: bold;">HR (bum)</span></p>
</td>
<td style="vertical-align:top; width:130px; height:12px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 8pt; font-weight: bold;">dtl_PatientVitals</span></p>
</td>
<td style="vertical-align:top; width:111px; height:12px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 8pt;">HR</span></p>
</td>
<td style="vertical-align:top; width:228px; height:12px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 8pt;">Field level validation boundaries: 30-200</span></p>
</td>
<td style="vertical-align:top; width:63px; height:12px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="color: #000000;">&nbsp;</span></p>
</td>
<td style="vertical-align:top; width:51px; height:12px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="color: #000000;">&nbsp;</span></p>
</td>
<td style="vertical-align:top; width:62px; height:12px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="color: #000000;">&nbsp;</span></p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td style="vertical-align:top; width:36px; height:12px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="color: #000000;">&nbsp;</span></p>
</td>
<td style="vertical-align:top; width:152px; height:12px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 8pt; font-weight: bold;">BP Systolic (mm/Hg)</span></p>
</td>
<td style="vertical-align:top; width:130px; height:12px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 8pt; font-weight: bold;">dtl_PatientVitals</span></p>
</td>
<td style="vertical-align:top; width:111px; height:12px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 8pt;">BPSystolic</span></p>
</td>
<td style="vertical-align:top; width:228px; height:12px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 8pt;">Field level validation boundaries: 50-250</span></p>
</td>
<td style="vertical-align:top; width:63px; height:12px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="color: #000000;">&nbsp;</span></p>
</td>
<td style="vertical-align:top; width:51px; height:12px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="color: #000000;">&nbsp;</span></p>
</td>
<td style="vertical-align:top; width:62px; height:12px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="color: #000000;">&nbsp;</span></p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td style="vertical-align:top; width:36px; height:12px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="color: #000000;">&nbsp;</span></p>
</td>
<td style="vertical-align:top; width:152px; height:12px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 8pt; font-weight: bold;">BP Diastolic (mm/Hg)</span></p>
</td>
<td style="vertical-align:top; width:130px; height:12px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 8pt; font-weight: bold;">dtl_PatientVitals</span></p>
</td>
<td style="vertical-align:top; width:111px; height:12px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 8pt;">BPDiastolic</span></p>
</td>
<td style="vertical-align:top; width:228px; height:12px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 8pt;">Field level validation boundaries: 30-150</span></p>
</td>
<td style="vertical-align:top; width:63px; height:12px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="color: #000000;">&nbsp;</span></p>
</td>
<td style="vertical-align:top; width:51px; height:12px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="color: #000000;">&nbsp;</span></p>
</td>
<td style="vertical-align:top; width:62px; height:12px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="color: #000000;">&nbsp;</span></p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td style="vertical-align:top; width:36px; height:23px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="color: #000000;">&nbsp;</span></p>
</td>
<td style="vertical-align:top; width:152px; height:23px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 8pt; font-weight: bold;">Ht (cm)</span></p>
</td>
<td style="vertical-align:top; width:130px; height:23px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 8pt; font-weight: bold;">dtl_PatientVitals</span></p>
</td>
<td style="vertical-align:top; width:111px; height:23px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 8pt;">Height</span></p>
</td>
<td colspan="3" style="vertical-align:top; width:228px; height:23px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 8pt;">Field level valdiation boundaries: 0-250</span></p>
<p style="margin: 0px 0px 0px 0px;"><span style="font-size: 8pt;">Auto populate from the IE form</span></p>
</td>
<td style="vertical-align:top; width:62px; height:23px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 8pt;">Yes</span></p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td style="vertical-align:top; width:36px; height:12px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="color: #000000;">&nbsp;</span></p>
</td>
<td style="vertical-align:top; width:152px; height:12px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 8pt; font-weight: bold;">Wt (kg)</span></p>
</td>
<td style="vertical-align:top; width:130px; height:12px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 8pt; font-weight: bold;">dtl_PatientVitals</span></p>
</td>
<td style="vertical-align:top; width:111px; height:12px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 8pt;">Weight</span></p>
</td>
<td style="vertical-align:top; width:228px; height:12px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 8pt;">Field level validation boundaries: 0-225</span></p>
</td>
<td style="vertical-align:top; width:63px; height:12px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="color: #000000;">&nbsp;</span></p>
</td>
<td style="vertical-align:top; width:51px; height:12px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="color: #000000;">&nbsp;</span></p>
</td>
<td style="vertical-align:top; width:62px; height:12px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 8pt;">Yes</span></p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td style="vertical-align:top; width:36px; height:12px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="color: #000000;">&nbsp;</span></p>
</td>
<td style="vertical-align:top; width:152px; height:12px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 8pt; font-weight: bold;">Pain</span></p>
</td>
<td style="vertical-align:top; width:130px; height:12px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 8pt; font-weight: bold;">dtl_PatientVitals</span></p>
</td>
<td style="vertical-align:top; width:111px; height:12px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 8pt;">Pain</span></p>
</td>
<td style="vertical-align:top; width:228px; height:12px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 8pt;">Pain is on a scale of 1 to 10.</span></p>
</td>
<td style="vertical-align:top; width:63px; height:12px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="color: #000000;">&nbsp;</span></p>
</td>
<td style="vertical-align:top; width:51px; height:12px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="color: #000000;">&nbsp;</span></p>
</td>
<td style="vertical-align:top; width:62px; height:12px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="color: #000000;">&nbsp;</span></p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td style="vertical-align:top; width:36px; height:12px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="color: #000000;">&nbsp;</span></p>
</td>
<td style="vertical-align:top; width:152px; height:12px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="color: #000000;">&nbsp;</span></p>
</td>
<td style="vertical-align:top; width:130px; height:12px; padding:0px; border:solid 1px #000000;"><p style="text-align: right; margin: 0px 0px 0px 0px;"><span style="color: #000000;">&nbsp;</span></p>
</td>
<td style="vertical-align:top; width:111px; height:12px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="color: #000000;">&nbsp;</span></p>
</td>
<td style="vertical-align:top; width:228px; height:12px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="color: #000000;">&nbsp;</span></p>
</td>
<td style="vertical-align:top; width:63px; height:12px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="color: #000000;">&nbsp;</span></p>
</td>
<td style="vertical-align:top; width:51px; height:12px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="color: #000000;">&nbsp;</span></p>
</td>
<td style="vertical-align:top; width:62px; height:12px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="color: #000000;">&nbsp;</span></p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td style="vertical-align:top; width:36px; height:12px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 8pt; font-weight: bold;">14</span></p>
</td>
<td style="vertical-align:top; width:152px; height:12px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 8pt; font-weight: bold;">ARV Side Effects</span></p>
</td>
<td style="vertical-align:top; width:130px; height:12px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="color: #000000;">&nbsp;</span></p>
</td>
<td style="vertical-align:top; width:111px; height:12px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="color: #000000;">&nbsp;</span></p>
</td>
<td style="vertical-align:top; width:228px; height:12px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="color: #000000;">&nbsp;</span></p>
</td>
<td style="vertical-align:top; width:63px; height:12px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="color: #000000;">&nbsp;</span></p>
</td>
<td style="vertical-align:top; width:51px; height:12px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="color: #000000;">&nbsp;</span></p>
</td>
<td style="vertical-align:top; width:62px; height:12px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="color: #000000;">&nbsp;</span></p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td style="vertical-align:top; width:36px; height:69px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="color: #000000;">&nbsp;</span></p>
</td>
<td style="vertical-align:top; width:152px; height:69px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 8pt; font-weight: bold;">Non, Recent weight loss, fever, etc…</span></p>
</td>
<td style="vertical-align:top; width:130px; height:69px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 8pt; font-weight: bold;">dtl_PatientSymptoms</span></p>
</td>
<td style="vertical-align:top; width:111px; height:69px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 8pt;">SymptomID</span></p>
</td>
<td colspan="3" style="vertical-align:top; width:228px; height:69px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 8pt;">Default the UI to None; Not documented button is available </span></p>
<p style="margin: 0px 0px 0px 0px;"><span style="font-size: 8pt;">if other complaints are selected, None becomes de-selected.</span></p>
<p style="margin: 0px 0px 0px 0px;"><span style="font-size: 8pt;">mst_SymptomCategory = ARV Side Effect</span></p>
</td>
<td style="vertical-align:top; width:62px; height:69px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 8pt;">Yes [none, conditions entered or not documented must be filled in]</span></p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td style="vertical-align:top; width:36px; height:12px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 8pt; font-weight: bold;">15</span></p>
</td>
<td colspan="2" style="vertical-align:top; width:152px; height:12px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 8pt; font-weight: bold;">HIV Associated Conditions/OIs or AIDs Defining Illness</span></p>
</td>
<td style="vertical-align:top; width:111px; height:12px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="color: #000000;">&nbsp;</span></p>
</td>
<td style="vertical-align:top; width:228px; height:12px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="color: #000000;">&nbsp;</span></p>
</td>
<td style="vertical-align:top; width:63px; height:12px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="color: #000000;">&nbsp;</span></p>
</td>
<td style="vertical-align:top; width:51px; height:12px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="color: #000000;">&nbsp;</span></p>
</td>
<td style="vertical-align:top; width:62px; height:12px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="color: #000000;">&nbsp;</span></p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td style="vertical-align:top; width:36px; height:69px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="color: #000000;">&nbsp;</span></p>
</td>
<td style="vertical-align:top; width:152px; height:69px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 8pt; font-weight: bold;">None, Pulmonary TB, Extrapulmonary TB, etc…</span></p>
</td>
<td style="vertical-align:top; width:130px; height:69px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 8pt; font-family: Tahoma; font-weight: bold;">dtl_PatientDisease </span></p>
</td>
<td style="vertical-align:top; width:111px; height:69px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 8pt; font-family: Tahoma;">Disease_pk, DiseaseName</span></p>
</td>
<td colspan="3" style="vertical-align:top; width:228px; height:69px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 8pt;">The date for any checked condition will be the visit date (as opposed the the IE form where the dates are explicitely given by the patient.)</span></p>
</td>
<td style="vertical-align:top; width:62px; height:69px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 8pt;">Yes [none, conditions entered or not documented must be filled in]</span></p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td style="vertical-align:top; width:36px; height:12px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 8pt; font-weight: bold;">16</span></p>
</td>
<td style="vertical-align:top; width:152px; height:12px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 8pt; font-weight: bold;">Assessment</span></p>
</td>
<td style="vertical-align:top; width:130px; height:12px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="color: #000000;">&nbsp;</span></p>
</td>
<td style="vertical-align:top; width:111px; height:12px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="color: #000000;">&nbsp;</span></p>
</td>
<td style="vertical-align:top; width:228px; height:12px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="color: #000000;">&nbsp;</span></p>
</td>
<td style="vertical-align:top; width:63px; height:12px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="color: #000000;">&nbsp;</span></p>
</td>
<td style="vertical-align:top; width:51px; height:12px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="color: #000000;">&nbsp;</span></p>
</td>
<td style="vertical-align:top; width:62px; height:12px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="color: #000000;">&nbsp;</span></p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td style="vertical-align:top; width:36px; height:23px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="color: #000000;">&nbsp;</span></p>
</td>
<td style="vertical-align:top; width:152px; height:23px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 8pt; font-weight: bold;">Clinical Assessment</span></p>
</td>
<td style="vertical-align:top; width:130px; height:23px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 8pt; font-family: Tahoma; font-weight: bold;">dtl_PatientAssessment </span></p>
</td>
<td style="vertical-align:top; width:111px; height:23px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 8pt;">AssessmentID</span></p>
</td>
<td colspan="3" style="vertical-align:top; width:228px; height:23px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 8pt;">Note that these assessment types are different than on the IE form.</span></p>
</td>
<td style="vertical-align:top; width:62px; height:23px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 8pt;">Yes</span></p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td style="vertical-align:top; width:36px; height:12px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="color: #000000;">&nbsp;</span></p>
</td>
<td style="vertical-align:top; width:152px; height:12px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 8pt; font-weight: bold;">WAB Stage</span></p>
</td>
<td style="vertical-align:top; width:130px; height:12px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 8pt; font-weight: bold;">dtl_PatientStage</span></p>
</td>
<td style="vertical-align:top; width:111px; height:12px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 8pt;">WABStage</span></p>
</td>
<td style="vertical-align:top; width:228px; height:12px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="color: #000000;">&nbsp;</span></p>
</td>
<td style="vertical-align:top; width:63px; height:12px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="color: #000000;">&nbsp;</span></p>
</td>
<td style="vertical-align:top; width:51px; height:12px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="color: #000000;">&nbsp;</span></p>
</td>
<td style="vertical-align:top; width:62px; height:12px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 8pt;">Yes</span></p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td style="vertical-align:top; width:36px; height:12px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="color: #000000;">&nbsp;</span></p>
</td>
<td style="vertical-align:top; width:152px; height:12px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 8pt; font-weight: bold;">WHO Stage</span></p>
</td>
<td style="vertical-align:top; width:130px; height:12px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 8pt; font-weight: bold;">dtl_PatientStage</span></p>
</td>
<td style="vertical-align:top; width:111px; height:12px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 8pt;">WHOStage</span></p>
</td>
<td style="vertical-align:top; width:228px; height:12px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="color: #000000;">&nbsp;</span></p>
</td>
<td style="vertical-align:top; width:63px; height:12px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="color: #000000;">&nbsp;</span></p>
</td>
<td style="vertical-align:top; width:51px; height:12px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="color: #000000;">&nbsp;</span></p>
</td>
<td style="vertical-align:top; width:62px; height:12px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 8pt;">Yes</span></p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td style="vertical-align:top; width:36px; height:12px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="color: #000000;">&nbsp;</span></p>
</td>
<td style="vertical-align:top; width:152px; height:12px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="color: #000000;">&nbsp;</span></p>
</td>
<td style="vertical-align:top; width:130px; height:12px; padding:0px; border:solid 1px #000000;"><p style="text-align: right; margin: 0px 0px 0px 0px;"><span style="color: #000000;">&nbsp;</span></p>
</td>
<td style="vertical-align:top; width:111px; height:12px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="color: #000000;">&nbsp;</span></p>
</td>
<td style="vertical-align:top; width:228px; height:12px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="color: #000000;">&nbsp;</span></p>
</td>
<td style="vertical-align:top; width:63px; height:12px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="color: #000000;">&nbsp;</span></p>
</td>
<td style="vertical-align:top; width:51px; height:12px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="color: #000000;">&nbsp;</span></p>
</td>
<td style="vertical-align:top; width:62px; height:12px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="color: #000000;">&nbsp;</span></p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td style="vertical-align:top; width:36px; height:12px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 8pt; font-weight: bold;">17</span></p>
</td>
<td style="vertical-align:top; width:152px; height:12px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 8pt; font-weight: bold;">ARV Therapy</span></p>
</td>
<td style="vertical-align:top; width:130px; height:12px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="color: #000000;">&nbsp;</span></p>
</td>
<td style="vertical-align:top; width:111px; height:12px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="color: #000000;">&nbsp;</span></p>
</td>
<td style="vertical-align:top; width:228px; height:12px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="color: #000000;">&nbsp;</span></p>
</td>
<td style="vertical-align:top; width:63px; height:12px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="color: #000000;">&nbsp;</span></p>
</td>
<td style="vertical-align:top; width:51px; height:12px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="color: #000000;">&nbsp;</span></p>
</td>
<td style="vertical-align:top; width:62px; height:12px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="color: #000000;">&nbsp;</span></p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td style="vertical-align:top; width:36px; height:23px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="color: #000000;">&nbsp;</span></p>
</td>
<td style="vertical-align:top; width:152px; height:23px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 8pt; font-weight: bold;">Treatment not indicated now</span></p>
</td>
<td style="vertical-align:top; width:130px; height:23px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 8pt; font-weight: bold;">dtl_PatientArvTherapy</span></p>
</td>
<td style="vertical-align:top; width:111px; height:23px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 8pt;">TherapyPlan</span></p>
</td>
<td style="vertical-align:top; width:228px; height:23px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 8pt;">For non-paperless, this is a required field;</span></p>
<p style="margin: 0px 0px 0px 0px;"><span style="font-size: 8pt;">For paperless, this is not a requied field.</span></p>
</td>
<td colspan="2" style="vertical-align:top; width:63px; height:23px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 8pt;">Yes, for non-paperless</span></p>
</td>
<td style="vertical-align:top; width:62px; height:23px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 8pt;">Yes, for non-paperless</span></p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td style="vertical-align:top; width:36px; height:12px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="color: #000000;">&nbsp;</span></p>
</td>
<td style="vertical-align:top; width:152px; height:12px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 8pt; font-weight: bold;">Continue Current</span></p>
</td>
<td style="vertical-align:top; width:130px; height:12px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 8pt; font-weight: bold;">dtl_PatientArvTherapy</span></p>
</td>
<td style="vertical-align:top; width:111px; height:12px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 8pt;">TherapyPlan</span></p>
</td>
<td style="vertical-align:top; width:228px; height:12px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="color: #000000;">&nbsp;</span></p>
</td>
<td style="vertical-align:top; width:63px; height:12px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="color: #000000;">&nbsp;</span></p>
</td>
<td style="vertical-align:top; width:51px; height:12px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="color: #000000;">&nbsp;</span></p>
</td>
<td style="vertical-align:top; width:62px; height:12px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="color: #000000;">&nbsp;</span></p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td style="vertical-align:top; width:36px; height:12px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="color: #000000;">&nbsp;</span></p>
</td>
<td style="vertical-align:top; width:152px; height:12px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 8pt; font-weight: bold;">Restart Treatment</span></p>
</td>
<td style="vertical-align:top; width:130px; height:12px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 8pt; font-weight: bold;">dtl_PatientArvTherapy</span></p>
</td>
<td style="vertical-align:top; width:111px; height:12px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 8pt;">TherapyPlan</span></p>
</td>
<td style="vertical-align:top; width:228px; height:12px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="color: #000000;">&nbsp;</span></p>
</td>
<td style="vertical-align:top; width:63px; height:12px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="color: #000000;">&nbsp;</span></p>
</td>
<td style="vertical-align:top; width:51px; height:12px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="color: #000000;">&nbsp;</span></p>
</td>
<td style="vertical-align:top; width:62px; height:12px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="color: #000000;">&nbsp;</span></p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td style="vertical-align:top; width:36px; height:12px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="color: #000000;">&nbsp;</span></p>
</td>
<td style="vertical-align:top; width:152px; height:12px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 8pt; font-weight: bold;">Start New Treatment</span></p>
</td>
<td style="vertical-align:top; width:130px; height:12px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 8pt; font-weight: bold;">dtl_PatientArvTherapy</span></p>
</td>
<td style="vertical-align:top; width:111px; height:12px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 8pt;">TherapyPlan</span></p>
</td>
<td style="vertical-align:top; width:228px; height:12px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="color: #000000;">&nbsp;</span></p>
</td>
<td style="vertical-align:top; width:63px; height:12px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="color: #000000;">&nbsp;</span></p>
</td>
<td style="vertical-align:top; width:51px; height:12px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="color: #000000;">&nbsp;</span></p>
</td>
<td style="vertical-align:top; width:62px; height:12px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="color: #000000;">&nbsp;</span></p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td style="vertical-align:top; width:36px; height:23px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="color: #000000;">&nbsp;</span></p>
</td>
<td style="vertical-align:top; width:152px; height:23px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 8pt; font-weight: bold;">Change regimen reason code</span></p>
</td>
<td style="vertical-align:top; width:130px; height:23px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 8pt; font-weight: bold;">dtl_PatientArvTherapy</span></p>
</td>
<td style="vertical-align:top; width:111px; height:23px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 8pt;">TherapyReasonCode</span></p>
</td>
<td colspan="4" style="vertical-align:top; width:228px; height:23px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 8pt;">If currARVTherapy=Change treatment then TherapyReasonCode is required</span></p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td style="vertical-align:top; width:36px; height:23px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="color: #000000;">&nbsp;</span></p>
</td>
<td style="vertical-align:top; width:152px; height:23px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 8pt; font-weight: bold;">Stop regimen reason code</span></p>
</td>
<td style="vertical-align:top; width:130px; height:23px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 8pt; font-weight: bold;">dtl_PatientArvTherapy</span></p>
</td>
<td style="vertical-align:top; width:111px; height:23px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 8pt;">TherapyReasonCode</span></p>
</td>
<td colspan="4" style="vertical-align:top; width:228px; height:23px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 8pt;">If currARVTherapy=Stop treatment then TherapyReasonCode is required</span></p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td style="vertical-align:top; width:36px; height:23px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="color: #000000;">&nbsp;</span></p>
</td>
<td style="vertical-align:top; width:152px; height:23px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 8pt; font-weight: bold;">Notes</span></p>
</td>
<td style="vertical-align:top; width:130px; height:23px; padding:0px; border:solid 1px #000000;"><p style="text-align: right; margin: 0px 0px 0px 0px;"><span style="color: #000000;">&nbsp;</span></p>
</td>
<td style="vertical-align:top; width:111px; height:23px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 8pt;">Notes</span></p>
</td>
<td colspan="4" style="vertical-align:top; width:228px; height:23px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 8pt;">Free text field in the follow up form for clinicians to type in their clinical notes</span></p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td style="vertical-align:top; width:36px; height:12px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="color: #000000;">&nbsp;</span></p>
</td>
<td style="vertical-align:top; width:152px; height:12px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="color: #000000;">&nbsp;</span></p>
</td>
<td style="vertical-align:top; width:130px; height:12px; padding:0px; border:solid 1px #000000;"><p style="text-align: right; margin: 0px 0px 0px 0px;"><span style="color: #000000;">&nbsp;</span></p>
</td>
<td style="vertical-align:top; width:111px; height:12px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="color: #000000;">&nbsp;</span></p>
</td>
<td style="vertical-align:top; width:228px; height:12px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="color: #000000;">&nbsp;</span></p>
</td>
<td style="vertical-align:top; width:63px; height:12px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="color: #000000;">&nbsp;</span></p>
</td>
<td style="vertical-align:top; width:51px; height:12px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="color: #000000;">&nbsp;</span></p>
</td>
<td style="vertical-align:top; width:62px; height:12px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="color: #000000;">&nbsp;</span></p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td style="vertical-align:top; width:36px; height:12px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 8pt; font-weight: bold;">18</span></p>
</td>
<td style="vertical-align:top; width:152px; height:12px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 8pt; font-weight: bold;">Appointment Scheduling</span></p>
</td>
<td style="vertical-align:top; width:130px; height:12px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="color: #000000;">&nbsp;</span></p>
</td>
<td style="vertical-align:top; width:111px; height:12px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="color: #000000;">&nbsp;</span></p>
</td>
<td style="vertical-align:top; width:228px; height:12px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="color: #000000;">&nbsp;</span></p>
</td>
<td style="vertical-align:top; width:63px; height:12px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="color: #000000;">&nbsp;</span></p>
</td>
<td style="vertical-align:top; width:51px; height:12px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="color: #000000;">&nbsp;</span></p>
</td>
<td style="vertical-align:top; width:62px; height:12px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="color: #000000;">&nbsp;</span></p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td style="vertical-align:top; width:36px; height:35px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="color: #000000;">&nbsp;</span></p>
</td>
<td style="vertical-align:top; width:152px; height:35px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 8pt; font-weight: bold;">When is the patient's next appointment?</span></p>
</td>
<td style="vertical-align:top; width:130px; height:35px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 8pt; font-weight: bold;">Dtl_Patientappointment</span></p>
</td>
<td style="vertical-align:top; width:111px; height:35px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 8pt; font-weight: bold;">Appdate</span></p>
</td>
<td colspan="4" style="vertical-align:top; width:228px; height:35px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 8pt;">This needs to be tied into the schedule. The date should be automatically calculated based on appointment period.</span></p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td style="vertical-align:top; width:36px; height:24px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="color: #000000;">&nbsp;</span></p>
</td>
<td style="vertical-align:top; width:152px; height:24px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 8pt; font-weight: bold;">Next appointment date</span></p>
</td>
<td style="vertical-align:top; width:130px; height:24px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 8pt; font-weight: bold;">Dtl_patientappointment</span></p>
</td>
<td style="vertical-align:top; width:111px; height:24px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 8pt; font-weight: bold;">Appdate  </span></p>
</td>
<td colspan="2" style="vertical-align:top; width:228px; height:24px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 8pt;">The date can be entered directly. If a date is entered, then appPeriod is Null.</span></p>
</td>
<td style="vertical-align:top; width:51px; height:24px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 8pt;">Yes</span></p>
</td>
<td style="vertical-align:top; width:62px; height:24px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="color: #000000;">&nbsp;</span></p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td style="vertical-align:top; width:36px; height:24px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="color: #000000;">&nbsp;</span></p>
</td>
<td style="vertical-align:top; width:152px; height:24px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 8pt; font-weight: bold;">Appointment Reason</span></p>
</td>
<td style="vertical-align:top; width:130px; height:24px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 8pt; font-weight: bold;">Dtl_patientappointment</span></p>
</td>
<td style="vertical-align:top; width:111px; height:24px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 8pt; font-weight: bold;"> AppReason</span></p>
</td>
<td colspan="4" style="vertical-align:top; width:228px; height:24px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 8pt;">This is a new field: reasons are “Follow up”; “Lab test”; and “Treatment Preparation”</span></p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td style="vertical-align:top; width:36px; height:12px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 8pt;">19</span></p>
</td>
<td style="vertical-align:top; width:152px; height:12px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 8pt; font-weight: bold;">Signature</span></p>
</td>
<td style="vertical-align:top; width:130px; height:12px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 8pt; font-weight: bold;">dtl_PatientClinicalStatus </span></p>
</td>
<td style="vertical-align:top; width:111px; height:12px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 8pt;">signiture</span></p>
</td>
<td style="vertical-align:top; width:228px; height:12px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="color: #000000;">&nbsp;</span></p>
</td>
<td style="vertical-align:top; width:63px; height:12px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="color: #000000;">&nbsp;</span></p>
</td>
<td style="vertical-align:top; width:51px; height:12px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="color: #000000;">&nbsp;</span></p>
</td>
<td style="vertical-align:top; width:62px; height:12px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="color: #000000;">&nbsp;</span></p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td style="vertical-align:top; width:36px; height:34px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="color: #000000;">&nbsp;</span></p>
</td>
<td style="vertical-align:top; width:152px; height:34px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 8pt; font-weight: bold;">Print</span></p>
</td>
<td style="vertical-align:top; width:130px; height:34px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="color: #000000;">&nbsp;</span></p>
</td>
<td style="vertical-align:top; width:111px; height:34px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 8pt;">Print</span></p>
</td>
<td colspan="4" style="vertical-align:top; width:228px; height:34px; padding:0px; border:solid 1px #000000;"><p style="margin: 0px 0px 0px 0px;"><span style="font-size: 8pt;">This button is used to take hard copy of the form. This is basically feature of paperless, but is implemented for non paperless too</span></p>
</td>
</tr>
</table>
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